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Union Coalition Delegates Conference Zero Trends: Health as a Serious Economic Strategy

Union Coalition Delegates Conference Zero Trends: Health as a Serious Economic Strategy. Leadership: A Transformational Approach to Health UNIVERSITY OF MICHIGAN HEALTH MANAGEMENT RESEARCH CENTER Dee W. Edington.

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Union Coalition Delegates Conference Zero Trends: Health as a Serious Economic Strategy

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  1. Union Coalition Delegates Conference Zero Trends: Health as a Serious Economic Strategy Leadership: A Transformational Approach to Health UNIVERSITY OF MICHIGAN HEALTH MANAGEMENT RESEARCH CENTER Dee W. Edington

  2. Think about what it would be like if you worked in the best performing organization you could imagine and the best place to work. What words would you use to describe the workplace and how would you describe the workforce?

  3. Business Problem Currently, most costs associated with workplace and workforce performance are growing at an unsustainable rate How are we going to be successful in this increasingly competitive world without a healthy and high performing workplace and workforce? How can we turn costs into an investment?

  4. UM-HMRC Corporate Consortium • Steelcase (H) • Progressive (H) • JPMorgan Chase (H) • Affinity Health System (H) • SW MI Healthcare Coalition (H) • Wisconsin Education Association Trust (H) • Ford • Delphi • Kellogg • We Energies • General Motors • Crown Equipment • Delphi Automotive • Southern Company • University of Missouri • Medical Mutual of Ohio • Florida Power and Light • St Luke’s Health System • St Joseph Health System • Allegiance Health System • Cuyahoga Community College • United Auto Workers-General Motors • American Construction Benefits Group • Australian Health Management Corporation *The consortium members provide health care insurance for over two million individuals. Data are available from three to 20 years. Meets on First Wednesday of each December in Ann Arbor.

  5. Union Coalition Delegates Conference Zero Trends: Health as a Serious Business and Economic Strategy March 25, 2011 Natural Flow of a Population High Risks and High Costs Business Case Health as a Serious Business and Economic Strategy Mission Change the Economic Assumptions from Treating Disease to the 21st Century Assumptions about Creating and Maintaining Healthy Populations Solution Engage Champion Companies in Systematic, Systemic and Sustainable Five Pillars which Promote a Healthy and High Performing Workplace and Workforce

  6. Section I The Current Healthcare Strategy Natural Flow Wait for Disease and then Treat (…in Quality terms this strategy translates into “wait for defects and then fix the defects” …)

  7. Health Risk Measure Body Weight Stress Safety Belt Usage Physical Activity Blood Pressure Life Satisfaction Smoking Perception of Health Illness Days Existing Medical Problem Cholesterol Alcohol Zero Risk High Risk 41.8% 31.8% 28.6% 23.3% 22.8% 22.4% 14.4% 13.7% 10.9% 9.2% 8.3% 2.9% 14.0% Estimated Health Risks From the UM-HMRC Medical Economics Report Estimates based on the age-gender distribution of a specific corporate employee population OVERALL RISK LEVELS Low Risk 0-2 risks Medium Risk 3-4 risks High Risk 5 or more

  8. Risk Transitions (Natural Flow) Time 1–Time 2 2,373 (50.6%) 4,691 (10.8%) 1,961 (18.4%) 5,226 (12.1%) 892 (3.2%) 4,546 (42.6%) 10,670 (24.6%) 1640 (35.0%) 678 (14.4%) 11,495 (26.5%) 5,309 (19.0%) 4,163 (39.0%) 27,951 (64.5%) 26,591 (61.4%) 21,750 (77.8%) High Risk (>4 risks) Medium Risk (3 - 4 risks) Low Risk (0 - 2 risks) Average of three years between measures Modified from Edington, AJHP. 15(5):341-349, 2001

  9. Total Medical and Pharmacy Costs Paid by Quarter for Three Groups The 20-80 rule is always true but terrifically flawed as a strategy Musich,Schultz, Burton, Edington. DM&HO. 12(5):299-326,2004

  10. Costs Associated with Risks Medical Paid Amount x Age x Risk AnnualMedicalCosts High Med Risk Non-Participant Low AgeRange Edington. AJHP. 15(5):341-349, 2001

  11. Section I: Four Learning Concepts The flow of Risks is to High-Risks The flow of Costs it to High-Costs Without early identification, the High Cost Spike is not Modifiable Costs follow Risks and Age

  12. Section II Build the Business Case for the Health as a Serious Economic Strategy (200+ Publications) Engage the Total Population to get to the Total Value of Health Complex Systems (Synergy & Emergence) versus Reductionism (Etiology)

  13. Excess Diseases Associated with Excess Risks (Heart, Diabetes, Cancer, Bronchitis, Emphysema Percent with Disease High Med Risk Low Risk Age Range Musich, McDonald, Hirschland, Edington. Disease Management & Health Outcomes 10(4):251-258, 2002.

  14. Non-Participants (N=4,649) Low Risk 0-2 Risks (N=685) Medium Risk 3-4 Risks (N=520) High Risk 5+ Risks (N=366) 25.4% 23.4% 49.9% 61.3% 30.2% 30.8% 63.1% 72.5% 30.2% 29.6% 41.0% 64.4% 38.0% 46.7% 69.7% 81.7% Percentage of Employees with a Disability Claim by Risk Status* HRA Participants 1998-2000 HRA WC Claims STD Claims Absence Record Disability Claim *Over three years 1998-2000 Wright, Beard, Edington. JOEM. 44(12):1126-1134, 2002

  15. Excess Disability Costs due to Excess Risks $1,248 $783 $666 $491 Wright, Beard, Edington. JOEM. 44(12):1126-1134, 2002

  16. Excess Medical Costs due to Excess Risks $5,520 $3,460 $3,039 $2,199 Edington, AJHP. 15(5):341-349, 2001

  17. Excess Pharmaceutical Costs due to Excess Risks $1,121 $754 $750 $567 $526 $443 $345 Burton, Chen, Conti, Schultz, Edington. JOEM. 45(8): 793-802. 2003

  18. Excess On-The-Job Loss due to Excess Risks 14.7% Burton, Chen, Conti, Schultz, Pransky, Edington. JOEM. 47(8):769-777. 2005

  19. Association of Risk Levels with Cost Measures Wright, Beard, Edington. JOEM. 44(12):1126-1134, 2002

  20. Change in Costs follow Change in Risks Cost increased Cost reduced Risks Reduced Risks Increased Overall: Cost per risk reduced: $215; Cost per risk avoided: $304 Actives: Cost per risk reduced: $231; Cost per risk avoided: $320 Retirees<65: Cost per risk reduced: $192; Cost per risk avoided: $621 Retirees>65: Cost per risk reduced: $214; Cost per risk avoided: $264 Updated from Edington, AJHP. 15(5):341-349, 2001.

  21. Medical and Drug Cost (Paid)* Slopes differ P=0.0132 Impr slope=$117/yr Nimpr slope=$614/yr Improved=Same or lowered risks

  22. Business Case Zero Trends follow “Don’t Get Worse” and “Help the Healthy People Stay Healthy”

  23. The Economics of Total Population Engagement and Total Value of Health Total Value of Health Medical/Hospital Drug Absence Disability Worker’s Comp Effective on Job Recruitment Retention Morale Low or No Risks Health Risks Disease increase increase decrease Where does cost turn into an investment?

  24. Section II: Four Learning Concepts Excess Risks lead to Excess Costs Risks Travel in Clusters Change in Risks lead to Change in Costs Controlling Risks leads to Zero Trends

  25. Health and Wellness Programs Healthier Person Better Employee Gains for The Organization 1. Health Status 2. Life Expectancy 3. Disease Care Costs 4. Health Care Costs 5. Productivity a. Absence b. Disability c. Worker’s Compensation d. Presenteeism e. Quality Multiplier 6. Recruitment/Retention 7. Company Visibility 8. Social Responsibility Lifestyle Change Health Management Programs 1981, 1995, 2000, 2006, 2008 D.W. Edington

  26. In December of 2006 we celebrated the first 30 years of our work: the Business Case was solid, although not yet perfect. Congratulations! However, nothing has changed in the population No more people doing physical activity No fewer people weighing less No fewer people with diabetes Why the disconnect between the business case and the intervention outcomes?

  27. A short Health & Performance Quiz If you continue to wait for defects and then try to fix the defects: Will you ever solve the fundamental problems? Is it better to keep a good customer or find a new one? Is the action you reward, the action that is sustained? If you put a changed person back into the same environment: Will the change be sustainable?

  28. The world we have made as a result of the level of thinking we have done thus far creates problems we cannot solve at the same level of thinking at which we created them. - Albert Einstein

  29. Where do we go next? TO A NEW LEVEL OF THINKING

  30. … to a Transformation from the Tired Old 20th Century Assumptions About Disease to the New 21st Century Assumptions About Healthy and High Performing Populations • From health as the absence of disease to health as vitality and energy • From only caring for the sick to enabling healthy people to stay healthy • From the cost of healthcare to the total value of health • From individual participation to population engagement • From behavior change to a Culture of Health

  31. Section III The Evidence-Based Solution: Zero Trends Integrate Health into the Environment and the Culture (…in Quality terms this strategy translates into “…fix the systems that lead to the defects” …)

  32. Vision for Zero Trends Zero Trends was written to be a transformational approach to the way organizations ensure a continuous healthy and high performing workplace and workforce Based upon 175 Research Publications

  33. Integrate Health into Core Business Healthier Person Better Employee Gains for The Organization 1. Health Status 2. Life Expectancy 3. Disease Care Costs 4. Health Care Costs 5. Productivity a. Absence b. Disability c. Worker’s Compensation d. Presenteeism e. Quality Multiplier 6. Recruitment/Retention 7. Company Visibility 8. Social Responsibility Lifestyle Change Company Culture and Environment SeniorLeadership Operations Leadership Self-Leadership Reward Positive Actions Quality Assurance Health Management Programs 1981, 1995, 2000, 2006, 2008 D.W. Edington

  34. Laying the groundwork for transformational change

  35. What is the value to you of a healthy and high performing champion workplace and workforce? To your organization? To your community?

  36. Characteristic of a Transformational Champion Organization Systematic Strategies Make the Solutions Systemic Make it Sustainable

  37. Transformation Pillar 5 Quality Assurance Where are you? Recognize Positive Actions Senior Leadership Operational Leadership Self-Leadership Quality Assurance Champion Comprehensive Traditional Do Nothing

  38. Senior Leadership • Create the Vision • Commitment to healthy culture • Connect vision to business strategy • Engage all leadership in vision “Establish the value of a healthy and high performing organization and workplace as a world-wide competitive advantage”

  39. Create the Vision Pillar 1: Senior Leadership • People are inspired by the purpose of the effort • People feel that their values and ideas are incorporated into what the organization is trying to achieve • People can easily communicate the direction of the effort • People recognize that both individual and organizational needs are being addressed • People see how their day-to-day activities can support the overall goals of the effort A Vision Must be Woven into Everything & Repeatedly Promoted!

  40. Example Vision - Intel

  41. OperationsLeadership • Align Workplace with the Vision • Brand health management strategies • Integrate policies into health culture • Engage everyone “You can’t put a changed person back into the same environment and expect the change to hold”

  42. The Transformation needs New Tools Next Generation Health Risk Assessments Corporate Culture and Environmental Audit and Gap Analyses Where do Employees go after Work? Community and Home From Best Practices to Next Practices

  43. What is a Culture of Health Pillar 2: Operations Leadership • A socially and structurally-constructed set of core attributes reflecting the prevailing values, underlying assumptions, expectations and definitions that members of a work organization collectively maintain. • The sum of these characteristics effect the way members think, feel, and behave related to matters of personal and group health.

  44. Promote SelfLeadership • Create Winners • “Champions” • Help employees not get worse • Help healthy people stay healthy • Provide improvement and maintenance strategies “Create winners, one step at a time and the first step is don’t get worse’

  45. Self-Leadership and High Performance • Consumerism • Engagement • Purpose-Values-Mission-Vision • Environment and culture • Personal • Control • Optimism • Resilience Self-leadership • Self-esteem • Vitality/ • Vigor • Confidence/ Self-efficacy • Social Support • Colleagues • Community • Family • Knowledge • Health Literacy • Negotiation Skills • Low-Risk Health Status Other possible *constructs: Change, Vision, Trust, Thrive, Enthusiasm, Ethics, Energy, Spirituality, Creativity, …

  46. Strategies Focused on Individuals Pillar 3: Self-leadership • Lifestyle/behavior change programs (e.g., programs to help employees stop smoking or abusing drugs, lose weight, or better manage stress) • Health and safety training (e.g., training employees on general workplace safety practices and those that apply to their specific jobs) • Clinical and preventive services (e.g., screenings and immunizations for employees and their families) Source: UCI Health Promotion Center, Workplace Health Promotion, Information and Resource Kit. http://www.seweb.uci.edu/users/dstokols/hpc.html

  47. Population Based Resources Pillar 3: Self-leadership • Business Specific Modules • Career Development • Communications • Financial Management • Social/Information Networks • Clinic or Medical Center • On-Line Information • Ergonomics • Vision • Dental • Hearing • Chiropractic • Complementary Care • Integrative Medicine • Physical Therapy • Weight Management • Physical Activity • Stress Management • Communications • Safety Belt Use • Smoking Cessation • Nutrition Education • On-Line Information • Nurse Line • Newsletters • Behavioral Health & EAP • Pharmacy Management • Case Management • Absence Management • Disability Management

  48. Recognize Positive Actions • Reinforce the Culture of Health • Recognize champions • Set recognition for healthy choices • Reinforce at every touch point “What is rewarded is what is sustained”

  49. Encourage Desired Behaviors Pillar 4: Recognize Action • Incentives Tied to Medical Plan Design: • Premium reduction • HRA completion • HRA credits to offset deductibles • Reduced co pays for preventative services • Reduced co pays for Rx adherence of certain drug classes • Non tobacco user incentive • Incentives Tied to Behaviors and Results: • Wellness rebates for participation in physical activity; weight management; tobacco cessation programs • Greater subsidy of healthy foods in cafes, lower costs to employees • Recognition of employees that improve their health through positive lifestyle changes

  50. Recognize Positive Action Pillar 4: Recognize Action Incentives can be tangible or intangible Tangible Incentives • Cash • Merchandise • Vacation days • Avoidance of costs (such as health care premiums or deductibles) Intangible Incentives • Extrinsic: • Recognition • Group competition • Acceptance and approval of peers • Intrinsic: • Personal challenges • A sense of accomplishment • A sense of belonging Can be the tipping point that moves someone from inaction to action The Science and Art of Motivating Healthy Behaviors, by Barry Hall, BENEFITS QUARTERLY, Second Quarter 2008. http://www.buckconsultants.com/buckconsultants/portals/0/documents/publications/published_articles/2008/Articles_Hall_Benefits_Quarterly_Q2_08.pdf

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